A patient who has been taking carbamazepine (Tegretol) for 2 ...

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A patient who has been taking carbamazepine (Tegretol) for 2 months has all of the following blood laboratory results. Which result does the nurse report to the prescriber immediately?
 
  a. White blood cell (WBC) count 2200/mm3
  b. Platelet count 300,000/mm3
  c. Potassium 3.6 mEq/L
  d. Sodium 132 mEq/L

Question 2

A patient is receiving IV caspofungin (Cancidas). Which assessments are most important for the nurse to perform daily? (Select all that apply.)
 
  a. Assessing both calves for swelling, redness, and pain
  b. Examining the skin for rash and blisters
  c. Assessing capillary refill in fingers and toes
  d. Assessing the injection site for irritation or phlebitis
  e. Reviewing laboratory reports of white blood cell counts
  f. Listening for bowel sounds in all four abdominal quadrants
  g. Reviewing laboratory reports for blood urea nitrogen (BUN) and creatinine

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Answer to Question 1

A
Carbamazepine can suppress bone marrow activity and decrease the number of WBCs. This pa-tient's WBC count is much lower than normal (normal range is 5000 to 10,000/mm3), greatly increasing his or her risk for infection. The drug must be discontinued as soon as possible (but not abruptly). The blood sodium level is slightly low as well, but it is not an immediate problem.

Answer to Question 2

A, B, D, G
Echinocandins can increase the rate of clot formation, which increases the risk for deep vein thrombosis (DVT). DVT is most likely to occur in the veins of the lower legs and in the pelvis. Symptoms of DVT in an extremity include swelling, warmth, and pain or discomfort. All the systemic antifungal agents can cause renal insufficiency. Anyone prescribed these drugs must have renal function monitored. Any intravenous antifungal drug can irritate veins and cause phlebitis. Skin irritation and rashes can occur with systemic antifungal therapy. Rashes may be severe with many types of lesions (Stevens-Johnson syndrome). If the rashes become widespread with crusting, fever, and tissue necrosis, the condition can be life-threatening. Echinocandins do not affect intestinal motility or capillary refill. They also do not directly affect bone marrow production of white blood cells.